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The Professor Position and the Single-Stance Flexion Test May Clarify the Effect of Lumbar Spinal Stenosis or Pseudostenosis on Lower-Extremity Symptoms

Stuart M. Goldman Department of Surgery, Sinai Hospital, 6005 Stuart Ave, Baltimore, MD 21209. (E-mail: PodMohel@gmail.com)

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The effect of lumbar spinal stenosis on lower-extremity symptoms is often hard to ascertain in patients with multiple possible causes of symptoms. A positive response to two described maneuvers performed by patients in the office involving flexion of the spine can strongly corroborate the contribution of lumbar spinal stenosis to lower-extremity symptoms, although a negative response does not negate it. The professor position involves the patient standing and leaning in a gentle flexion position, with hands held secure behind the lower back. The single-stance flexion test has the patient gently leaning on support, with only a single symptomatic extremity supporting his or her body weight. Reduction or elimination of lower-extremity symptoms otherwise experienced in an erect position suggests that spine position contributes significantly to the overall lower-extremity symptoms, in addition to or instead of weightbearing or dependent positioning. These maneuvers may be effective in either lumbar spinal stenosis or pseudostenosis, a condition in which lower-extremity mechanical dysfunction induces spinal dysfunction mimicking or exacerbating symptoms of lumbar spinal stenosis. Success with either maneuver can suggest to both physician and patient the potential value of positional testing with a rolling walker as a therapeutic intervention. Further research is necessary. Clinical use may be indicated. (J Am Podiatr Med Assoc 103(2): 156–160, 2013)